Up Front: April 2010

Eye of the needle

Scars fleck my flesh. Many were inflicted by folly, like the now nearly invisible one at the corner of my right eye, etched when I toppled into a toy box as a toddler. (A man’s reach should, indeed, exceed his grasp but not a 1-year-old’s.) Others, more precise, linger where scalpels once sliced skin. That both my hands don’t bear these in abundance is a testament to a surgeon’s curiosity, compassion and skill, but they make a mockery of the economics underlying American medicine.

Among the afflictions I’m heir to is one called Dupuytren’s contracture, which causes the fascia, a layer of tissue just beneath the skin of the palm, to harden and shrink, forming lateral cords that keep the fingers, especially ring and pinkie, from straightening. Eventually they bend, curling like claws. Rarely painful, it’s not malignant, but if you make a living with your hands — or as I’m doing now, pecking a keyboard — it becomes a major pain in another part of your anatomy. Even putting your hand in your pocket can be a trial.

Standard surgery involves cutting open the palm to excise the fibrous tissue. This not only requires stitches, splints and postoperative therapy but risks complications such as infection and nerve damage. Because there is a 50/50 chance the nodes will grow back, the resulting scar tissue makes another fasciectomy even more difficult. The first hand surgeon I consulted cautioned me to wait. Over the course of a decade, I watched my fingers — first on my left, then my right — tick down like the minute hand on a clock as the quarter-hour approaches.

Prowling the Internet, I read everything I could find about Dupuytren’s. That’s how I learned about needle aponeurotomy. Pioneered by a rheumatologist in Paris, the procedure is performed by few doctors in this country. Simply put, it involves poking a small-gauge hypodermic needle into the cords, fraying them until they can be snapped by straightening the fingers. A clinic in West Palm Beach, Fla., was not only doing it but training others. Clicking through its site, I came across a photo of Dr. Richard D. Goldner, an orthopedic surgeon at Duke University Medical Center. (Ironically, I could have found him in the pages of BNC, in our annual listing of the state’s best doctors. For the latest, see our November issue.)

In the fall of 2008, he spent nearly four hours freeing the fingers of my left hand. Last October, he spent two more on my right as we chatted — the procedure requires only local anesthetic, numbing just the skin — about the pros and cons of Obamacare. Then I drove to my brother’s house outside Hillsborough and, the next morning, home to Charlotte, losing only a day of work.

Needle aponeurotomy is tedious, especially for a surgeon of Dr. Goldner’s caliber, and it pays poorly. I know, because just the other day my insurance company sent a letter informing me, five months later, that it was my responsibility, as part of my annual deductible, to pay the provider the $285 it had approved of the $1,712 that was billed. If money had mattered that much to him, Dr. Goldner would have had an economic incentive to flay open my palms, a fasciectomy being much more lucrative for him and the hospital.

So with straightened hand, I salute such healers. But this I must confess: I sometimes catch myself yearning to use it to slap the mouths of those who say this flawed health-care system is the best there is and that we should just let it be.

Due to a data-entry error by the North Carolina Golf Panel, Hope Valley Country Club in Durham was omitted from the top 100 golf courses in the March issue. It ranks 53rd. The corrected list can be viewed at www.ncgolfpanel.com.